Claims Customer Service Advocate II

CGS Administrators, LLC

Claims Customer Service Advocate assisting customers with inquiries and processing claims for CGS/BlueCross BlueShield of South Carolina. Ensuring effective customer relations and examining claims per business regulations.

Posted 6/6/2026full-timeNashville • Tennessee • 🇺🇸 United StatesJuniorMid-LevelWebsite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

claims processingappeals processingcoding of proceduresdiagnosis codesbusiness math proficiency

Soft Skills

customer serviceverbal communicationwritten communicationattention to detaildiscretion

Tools & Technologies

Microsoft Office

Certifications & Qualifications

High School DiplomaBachelor's Degree

Industry Keywords

quality standardsproduction standardsfraud detectioninternal standardsbusiness regulations

About the role

Key responsibilities & impact

Respond accurately, timely, and courteously to telephone, written, web, or walk-in inquiries.
Handle situations which may require adaptation of response or extensive research.
Identify incorrectly processed claims and process adjustments and reprocessing actions according to department guidelines.
Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.
Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes.
Ensure claims are processing according to established quality and production standards.
Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refer these to a lead or manager for resolution.
Identify and report potential fraud and abuse situations.

Requirements

What you’ll need

High School Diploma or equivalent
2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience.
Good verbal and written communication skills.
Strong customer service skills.
Good spelling, punctuation and grammar skills.
Basic business math proficiency.
Ability to handle confidential or sensitive information with discretion.
Proficiency in Microsoft Office.

Benefits

Comp & perks

Subsidized health plans
Dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more